Falsely PMB Policy

<p>On 18 September 2016 I was rushed in an unconscious state to Netcare Unitas Hospital. I was resuscitated and admitted, after which I was in a comatose state for ±1.5 days. I was discharged from Netcare Unitas Hospital on 22 September 2016.</p> <p> </p> <p>I have a PMB condition under which my admission was granted. The hospital bill hasn’t been paid in full by Discovery Health based on the following reason: “Auth ********** 5 is approved to pay at 80% - paid as per approval”.</p> <p>The policy for PBM however states: “You must use designated serviced providers in our network. This doesn’t apply in emergencies. However, even in these cases, where appropriate and according to the rules of the Scheme, you may be transferred to a hospital or other service provider in our network, once stabilised.” </p> <p>Note: "This doesn't apply in emergencies" "You may be transferred to a hospital in the network". Never did the Hospital transfer me as I was not "stabilised" hence the full amount should be covered.</p> <p>I had to pay a ±R10 000 account to avoid legal action against me. </p> <p>My expectation from Discovery Health is to reimburse me with the full amount since this ordeal is causing unnecessary stress on me and may worsen my general wellbeing.</p> <p> </p> <p>I await your urgent feedback.</p> <p> </p>